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Ex vivo biomechanical analysis of the Ross procedure using the modified inclusion technique in a 3-dimensionally printed left heart simulator
The Journal of Thoracic and Cardiovascular Surgery ( IF 6 ) Pub Date : 2021-09-16 , DOI: 10.1016/j.jtcvs.2021.06.070
Yuanjia Zhu 1 , Mateo Marin-Cuartas 2 , Matthew H Park 3 , Annabel M Imbrie-Moore 3 , Robert J Wilkerson 4 , Sarah Madira 4 , Danielle M Mullis 4 , Y Joseph Woo 1
Affiliation  

Objective

The inclusion technique was developed to reinforce the pulmonary autograft to prevent dilation after the Ross procedure. Anticommissural plication (ACP), a modification technique, can reduce graft size and create neosinuses. The objective was to evaluate pulmonary valve biomechanics using the inclusion technique in the Ross procedure with and without ACP.

Methods

Seven porcine and 5 human pulmonary autografts were harvested from hearts obtained from a meat abattoir and from heart transplant recipients and donors, respectively. Five additional porcine autografts without reinforcement were used as controls. The Ross procedure was performed using the inclusion technique with a straight polyethylene terephthalate graft. The same specimens were tested both with and without ACP. Hemodynamic parameter data, echocardiography, and high-speed videography were collected via the ex vivo heart simulator.

Results

Porcine autograft regurgitation was significantly lower after the use of inclusion technique compared with controls (P < .01). ACP compared with non-ACP in both porcine and human pulmonary autografts was associated with lower leaflet rapid opening velocity (3.9 ± 2.4 cm/sec vs 5.9 ± 2.4 cm/sec; P = .03; 3.5 ± 0.9 cm/sec vs 4.4 ± 1.0 cm/sec; P = .01), rapid closing velocity (1.9 ± 1.6 cm/sec vs 3.1 ± 2.0 cm/sec; P = .01; 1.8 ± 0.7 cm/sec vs 2.2 ± 0.3 cm/sec; P = .13), relative rapid opening force (4.6 ± 3.0 vs 7.7 ± 5.2; P = .03; 3.0 ± 0.6 vs 4.0 ± 2.1; P = .30), and relative rapid closing force (2.5 ± 3.4 vs 5.9 ± 2.3; P = .17; 1.4 ± 1.3 vs 2.3 ± 0.6; P = .25).

Conclusions

The Ross procedure using the inclusion technique demonstrated excellent hemodynamic parameter results. The ACP technique was associated with more favorable leaflet biomechanics. In vivo validation should be performed to allow direct translation to clinical practice.



中文翻译:

在 3 维打印的左心模拟器中使用改进的包含技术对 Ross 手术进行离体生物力学分析

客观的

开发包涵技术是为了加固自体肺移植物,以防止罗斯手术后扩张。反连合折叠术 (ACP) 是一种改良技术,可以减小移植物尺寸并产生新鼻窦。目的是在有或没有 ACP 的 Ross 手术中使用包合技术来评估肺动脉瓣生物力学。

方法

分别从肉类屠宰场以及心脏移植受者和供体获得的心脏中收获了7 个猪和 5 个人自体肺移植物另外五个未加固的猪自体移植物用作对照。Ross 手术是使用直聚对苯二甲酸乙二醇酯接枝物的包合技术进行的。相同的样本在使用和不使用 ACP 的情况下都进行了测试。通过离体心脏模拟器收集血流动力学参数数据、超声心动图和高速摄像。

结果

与对照组相比,使用包涵技术后猪自体移植物的反流率显着降低(P  < .01)。与猪和人自体肺移植物中的非 ACP 相比,ACP 与较低的小叶快速张开速度相关(3.9 ± 2.4 厘米/秒 vs 5.9 ± 2.4 厘米/秒;P = .03;3.5 ± 0.9 厘米/秒 vs 4.4 ± 0.9 厘米/ ) 1.0 厘米/秒;P  = .01),快​​速关闭速度(1.9 ± 1.6 厘米/秒 vs 3.1 ± 2.0 厘米/秒;P  = .01;1.8 ± 0.7 厘米/秒 vs 2.2 ± 0.3 厘米/秒;P  = .13)、相对快速打开力(4.6 ± 3.0 vs 7.7 ± 5.2;P  = .03;3.0 ± 0.6 vs 4.0 ± 2.1;P  = .30)和相对快速关闭力(2.5 ± 3.4 vs 5.9 ± 2.3;P  = .17;1.4 ± 1.3 与 2.3 ± 0.6;P  = .25)。

结论

使用包涵技术的罗斯手术显示出优异的血流动力学参数结果。ACP 技术与更有利的小叶生物力学相关。应进行体内验证,以便直接转化为临床实践。

更新日期:2021-09-16
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